Interfacility transfer of older adults: outcomes and opportunities for improving patient-centered care

PROJECT SUMMARY Each year, more than 250,000 older adults in the United States are transferred from the emergency department (ED) to another hospital for care, yet more than a quarter do not require specialized resources or procedures once transferred. It is unknown whether these potentially avoidable transfers positively impact patients or simply expose them to the risks of transfer without clear benefit as data on outcomes after interfacility transfer of older adults is lacking. Acutely ill or injured elderly patients may be particularly vulnerable to separation from their social support systems and are at increased risk for adverse events such as delirium and falls. Even justifiable transfers may not be concordant with patient preferences. This knowledge gap, combined with a lack of understanding of the experiences and specific challenges faced by older adults during transfer, limits physicians’ ability to provide fully informed, patient-centered care when considering whether to transfer an elderly patient. The overall objective of this proposal is to quantitatively and qualitatively advance our understanding of interfacility transfers of older adults and lay the groundwork for development of an intervention to optimize transfer decisions. This project proposes the following specific aims: 1) To characterize outcomes of older adults who experience interfacility transfer; 2) To explore older adult and care partner experiences with transfer; and 3) To identify factors influencing transfer decisions among key decision-makers. To accomplish Aim 1, we will quantify hospital outcomes and adverse events among transferred older adults, including clinically relevant subgroups of older adults, using statewide administrative claims data. For Aims 2 and 3, we will conduct interviews with patients, care partners, and other key individuals involved in the transfer process. This proposal is closely aligned with the “National Institute on Aging: Strategic Directions for Research, 2020-2025;” this investigation will be used to develop strategies to improve the interaction of older adults with the health system. Specifically, this work will translate to improvements in patient-centered care delivery for older adults potentially needing transfer. This GEMSSTAR project, professional development plan, and mentorship by accomplished clinician- researchers with complementary skill sets will help the PI acquire relevant skills to become a physician- scientist with expertise intersecting aging, emergency medicine, and patient-centered outcomes research. The findings will also serve as preliminary evidence to support a future Beeson career development award application to develop interventions to help older adults and their providers successfully navigate interfacility transfer decisions.